Contract Request Form

Thank you for your interest in joining the CeltiCare Health provider network.

We are excited that you have selected CeltiCare’s CarePlus provider network as your network of choice.

To get started, please complete the form below and someone from our Network Development team will respond back to you within two weeks. If we have a network need for your specialty or geographic area we will send you a packet which includes information required for credentialing. Please note that the plan is unable to approve all contract requests, but will keep them on file as network needs change often.

Attention Behavioral Health Providers: If you are interested in joining the network, you will be included through our Cenpatico network. Please click here to be taken to the appropriate page.

Required fields are marked with an asterisk (*)

Contact Information

Provider Information

Provider Identification Numbers